The EAU's contribution to the European Commission’s Consultation on Medical Countermeasures against Public Health Threats

Urinary tract infections (UTIs) are one of the most common infections in Europe and worldwide. These infections also play a major role in the growing problem of antimicrobial resistance (AMR), where bacteria become resistant to antibiotics.

Overusing and misusing antibiotics to treat UTIs makes this problem worse. It’s especially challenging in urological care, where procedures and devices like catheters can increase infection risk. 

The Scale of the Problem
The 2016 O’Neill Review warned that if AMR is not addressed, it could cause 10 million deaths each year by 2050. In response, the European Union (EU) named AMR one of its top three health threats and adopted new recommendations in 2023 to fight it using a One Health approach—connecting human, animal, and environmental health.

Key Challenges in Urological Care

1. Antibiotic Misuse: Using antibiotics when they’re not needed or using the wrong dose increases drug resistance.
2. Risk from Medical Devices: Long-term use of catheters and similar devices raises infection risk and may require stronger antibiotics.
3. Poor Use of Guidelines: Although guidelines exist, they are not used consistently, and infection data reporting is often weak.

Policy Recommendations for the EU
To reduce AMR in urology, the EU should take the following steps:

1. Support Innovation: Invest in research and development of new antibiotics, fast tests, vaccines, and non-antibiotic treatments for urinary infections.
2. Follow Guidelines: Encourage all EU countries to use existing clinical guidelines, like those from the European Association of Urology (EAU).
3. Improve Training and Stewardship: Expand programs that train healthcare workers to use antibiotics properly, especially in primary care, surgery, outpatient, and elderly care settings.
4. Boost Surveillance and Data Sharing: Strengthen EU-wide systems to track infections and resistance, like the ECDC and EARS-Net, and improve data sharing.
5. Invest in Research: Fund new studies on diagnostics, treatments, and ways to prevent infections, with a focus on solutions specific to urology.

Conclusion
Urological infections are a key contributor to antimicrobial resistance and require targeted, coordinated action. Integrating urology-specific strategies into broader EU health policies is essential. By promoting innovation, stewardship, and consistent clinical practice, Europe can protect antibiotic effectiveness and strengthen healthcare resilience for the future.